Orange County Benzodiazepine Addiction Treatment

Orange County Benzodiazepine Addiction Treatment

Benzodiazepines Defined

Benzodiazepines are one of the most popular classes of psychoactive drugs prescribed in the United States. From 1996 to 2013, the number of Americans who filled a benzodiazepine prescription rose by 67%, from just over 8 million to 13.5 million people.1 One reason for the popularity of benzodiazepines is that they can treat a wide variety of medical and mental health conditions including seizures, anxiety, muscle spasms, insomnia, as well as alcohol withdrawal syndrome.2 Out of the top 200 drugs sold in the United States in 2018, certain benzodiazepines ranked as follows:3

  • #23 Alprazolam
  • #38 Clonzapam
  • #55 Lorazepam
  • #91 Diazepam

How Benzodiazepines Work

Benzodiazepines work by affecting the central nervous system (CNS). The effects include sedation, decreased anxiety, muscle relaxation and anticonvulsant activity.  Benzodiazepine effects on the CNS are thought to be a product of GABA A receptors stimulation and the regulation of the brain’s neurotransmitters, which produces calming effects. 2 Commonly known benzodiazepines include the brand names Valium, Xanax and Klonopin.

However, taking benzodiazepines comes with risks. The National Institute for Drug Abuse (NIDA) reports that benzodiazepine overdose deaths rose steadily from 1,135 in 1999 to 11,537 in 2017 in the United States.4

A Brief History on Benzodiazepines

In the mid 1950s, Hoffmann La Roche company in New Jersey asked chemist Leo Sternbach to search for new drug compounds. In 1955, Sternbach created the chemical class of benzodiazepines. His first discovery, chlordiazepoxide, was patented in 1959 and sold as Librium in 1960. 5

The benzodiazepines drug class then became highly successful, because the sedative effects of the drugs acted effectively on anxiety, depression mixed with anxiety, and other conditions, while being deemed relatively safe at the time.5 Although as time passed, addictiveness did enter the picture.

In 1963, Roche introduced the benzodiazepine that became then the most successful drug in pharmaceutical history by the end of the 1960s: Valium, also known by its generic name, diazepam. By 1971, Librium and Valium brought in $200 million in sales for Roche, a hefty part of the total of $280 million in sales in the United States for Roche that year.5 By 1977, it was estimated that approximately 8,000 tons of benzodiazepines were being consumed each year in the United States.

Why Are Benzodiazepines Used?

Anxiety:

Benzodiazepines are used to treat anxiety-related conditions, such as Generalized Anxiety Disorder (GAD) because of the calming effects the drug has on the brain’s neurons. 

Seizure:

Benzodiazepines are powerful anticonvulsants that makes them highly effective for epileptic seizure prevention. 

Insomnia:

To avoid dependence, short-term use of benzodiazepines to treat insomnia may be effective in helping people get restful sleep. It’s especially effective when the person also has an anxiety disorder, because benzodiazepines can be used to treat both conditions simultaneously.   

Anesthesia:

Most commonly, the benzodiazepine drugs used to induce anesthesia include diazepam, flunitrazepam and midazolam, which help decrease stress before surgery. 

Muscle Relaxation:

As a result of the interactions that benzodiazepines have on the nervous system, people with muscle spasms can find relief via benzodiazepines. 

Alcohol Withdrawal:

The two most common benzodiazepines used in the treatment of alcohol withdrawal are chlordiazepoxide and diazepam. These drugs help individuals recovering from alcohol dependence by eliminating toxins from their bodies and decreasing risks of severe alcohol withdrawal reactions. 

Different Types of Benzodiazepines

Diazepam (Valium)

Diazepam is a benzodiazepine that is widely used as a muscle relaxant and to combat anxiety. When diazepam is administered intravenously, it can help alleviate severe agitation. It is also used as preparation for anesthesia, as well as a sedative for invasive procedures or minor surgeries. Diazepam is also used to treat epileptic seizures. It has been in use since 1963. 

Lorazepam (Ativan)

Lorazepam is a benzodiazepine that is widely used to treat insomnia and anxiety. It can also be used in sedation as well as treating vomiting and nausea. It has been in use since 1977. 

Alprazolam (Xanax)

Alprazolam is a benzodiazepine widely used in the treatment of anxiety and panic disorders. It has been in use since 1981. 

Clonazepam (Klonopin)

Clonazepam is a benzodiazepine mainly used as an anticonvulsant drug for treating epilepsy. It has been in use since 1997. 

Clorazepate (Tranxene)

Clorazepate is a benzodiazepine used as an anticonvulsant to manage epileptic seizures, as well as a drug for the treatment of anxiety and alcohol withdrawal. It has been in use since 1972. 

Midazolam (Versed)

Midazolam is a benzodiazepine administered intravenously as an anesthetic for conscious sedation or as a supplement in general anesthesia. It was approved for use in 1985.

Triazolam (Halcion)

Triazolam is an oral benzodiazepine used mostly in the treatment of insomnia. It has been in use since 1982. 

Estazolam (Prosom)

Estazolam is a benzodiazepine taken orally to treat insomnia. It has been in use since 1990. 

Temazepam (Restoril)

Temazepam is a benzodiazepine taken orally to treat insomnia. It has been in use since 1981. 

Chlordiazepoxide (Librium)

Chlordiazepoxide is a benzodiazepine taken orally to treat anxiety and alcohol withdrawal symptoms. It has been in use since 1960. 

Flurazepam (Dalmane)

Flurazepam is a benzodiazepine that is used as a sleeping aid in the treatment of insomnia. 

Common Misconceptions About Benzodiazepines

Misconception #1: Benzodiazepines carry little risk since they are prescribed medications

Many people mistakenly assume that when a drug is prescribed by a healthcare professional, the drug carries no risk. When a drug is taken as prescribed, it’s true there is little or no risk in most cases. But when benzodiazepines are misused, they can become harmful and can cause serious side effects and possibly death. Also, benzodiazepine tolerance can develop in as quickly as several weeks, even when it is being taken as prescribed. 

Misconception #2: You can’t overdose on benzodiazepines

In 2018, the National Institute on Drug Abuse (NIDA) reported that more than a third of overdoses attributed to opioids also involved benzodiazepines.1 In addition, mixing benzodiazepines with alcohol or other depressant drugs increases the risk for a negative reaction that can result in death.

Misconception #3: You can’t misuse prescription medications

Misuse and abuse of prescription medications is an urgent and growing health problem in the United States. NIDA reported that, in 2017, approximately 18 million people (6% of people 12 years of age and older) have misused prescription drugs at least one time in the past year. 6

What Do Benzodiazepines Do to the Body?

The exact way benzodiazepines work in the body is largely not known. The theory is that its calming, sedative and anti-seizure properties increase GABA (gamma aminobutyric acid) activity. GABA is the most common inhibitory neurotransmitter in the central nervous system.7 When stress and anxiety stimulate the brain, benzodiazepines inhibit the production of the “excitable” neurotransmitters, which slows down the stimulation, producing a sedative effect.

When taking benzodiazepines for the long-term, tolerance can build up to their short-term effects, which means the drugs are less effective for treating the symptoms they were prescribed for in the first place. People then may take more benzodiazepines, which can create dependence. Dependence happens when the brain’s circuitry changes to adjust to the drug’s existence. Once the reward center changes, cravings occur. When trying to control or stop benzodiazepines use, withdrawal symptoms can develop.

What Are the Side Effects from Benzodiazepines?

Dizziness:

Benzodiazepine withdrawal can cause you to feel dizzy and off balance. This is a common symptom that should go away in a few weeks.

Vertigo:

Vertigo, a disordered state of mind, can be a side effect of benzodiazepines, especially when taken with other classes of drugs, such as antidepressants. 

Fainting:

Losing consciousness can be caused by benzodiazepines as well as other medications. Fainting may be a sign of a more serious, life-threatening condition. 

Numbness:

Numbness in the extremities or the face can be a side effect of long-term benzodiazepine use. 

Impaired Cognition:

Cognitive impairment that is benzodiazepine induced can include amnesia, drowsiness, sedation, motor impairment, inattentiveness and lack of voluntary coordination of muscle movements.

Confusion:

A change in mental status to confusion results in an inability to think clearly, loss of ability to recognize people or places and feeling disoriented. 

Slow Reaction Time:

Since benzodiazepines have a sedative effect, it can also slow down reaction times. It’s important to understand the effects of these drugs before you operate heavy machinery or a motor vehicle. 

Impaired Judgement:

Due to the neurological effects that benzodiazepines have on the brain, impaired judgement can result. 

Reduced Libido:

One side effect of benzodiazepines is a decrease in sex drive. 

If you are experiencing one or more of these side effects, see your doctor. Benzodiazepines should never be stopped abruptly, but should be tapered off under the supervision of a healthcare professional. 

If you try to detox from benzodiazepines on your own, you could experience serious withdrawal symptoms, seizures and possibly death.

What Are the Withdrawal Symptoms from Benzodiazepines?

The mechanism of addiction to benzodiazepines is different from other classes of drugs. Most other drugs, such as opiates and stimulants, create pleasurable sensations when dopamine levels surge in the reward center of the brain.

Benzodiazepines do not trigger these dopamine surges. Rather, benzodiazepines diminish the power of the brain’s inhibitory neurons. These neurons normally help limit dopamine levels by decreasing the firing rates of neurons that produce dopamine and downregulating the number of receptors.

These two negatives produce a positive: when benzodiazepines restrict the neurons’ restraining effects, the dopamine neurons release more dopamine. 

Headaches:

If you experience nausea, it should go away within the first two weeks after your last dose. 

Stomach pain:

Abdominal pain is a common withdrawal reaction from benzodiazepines and should subside within the first week or two. 

Nausea:

Any nausea should lessen within the first week or two after your last benzodiazepine dose. 

Tremors:

Uncontrollable shakiness can occur when benzodiazepines are stopped, because of the tolerance that was built up from taking the medication for the long-term. 

Sweating:

Excessive sweating during the daytime and night sweats while you are trying to sleep can happen during benzodiazepine withdrawal. As your body adjusts to functioning without benzodiazepines, it may react by sweating until the adjustment is completed. 

Hallucinations:

It rarely occurs, but some people experience hallucinations during benzodiazepine withdrawal. 

Dizziness:

Benzodiazepine withdrawal can cause dizziness and feelings of instability, but these symptoms are common and should diminish in a few weeks. 

Fatigue:

It’s common to feel very tired and have a lack of motivation as withdrawal reactions are happening while you wean off benzodiazepines. Energy levels gradually return over time, but initially it may be hard to get started or accomplish anything. 

Confusion:

Confusion as a withdrawal reaction may be the result of poor cognitive functioning. Confusion usually improves gradually over the first several weeks. 

Anxiety:

Benzodiazepines act on the brain’s receptors to reduce anxiety. Without the drug, the GABA neurotransmitter activities are significantly affected, which can cause anxiety as a withdrawal reaction. 

Depression:

Feeling sad and depressed are common withdrawal reactions during the taper down of benzodiazepines as the body and brain adjust to the reduction. 

Seizures:

If you are taking benzodiazepines specifically to control seizures, you can experience an increased risk of developing seizures when you discontinue the drug. This risk increases if you withdraw too quickly. However, individuals without previous seizures have an increased risk of seizures if they taper down too quickly from benzodiazepines. 

Thoughts of Suicide:

Thinking about suicide, also called suicidal ideation, can be the result of depression that many go through during benzodiazepine withdrawal. If you feel sad, depressed and hopeless, suicidal thoughts may follow. If you have thoughts of suicide, tell someone on the detox staff. Thoughts of suicide are related to the withdrawal and should improve with time.

What Are Long-term Effects from Benzodiazepines?

Because of the risks of tolerance, dependence and withdrawal, long-term use of benzodiazepines is not recommended in most cases. Misuse is a common long-term effect that comes from tolerance. As people who use benzodiazepines for the treatment of anxiety or panic disorders start experiencing a return of their symptoms, they take more of the drug.

As people take more and more benzodiazepines, they build a dependence on these drugs. Dependence means that to feel “normal” and function each day, they need to take benzodiazepines. Without the drugs, they feel sick and distressed and are unable to carry out daily tasks. To safely recover from this cycle of addiction, detoxification is necessary.

What Is the Detox from Benzodiazepines Like?

Be sure to undergo a medically supervised detox for your health and safety. A home detox is not recommended, because there won’t be trained medical staff on hand to give you the medications you need to taper at the right pace and to alleviate symptoms as they arise. 

Medical Detox:

A benzodiazepine medical detox entails:

  • A gradual tapering down of the drug while you’re monitored by healthcare professionals. The benzodiazepine dosages are slowly reduced.
  • Gabapentin may be given to keep withdrawal symptoms to a minimum. Gabapentin is an antiseizure medication used in epilepsy seizure management; and it can also effectively treat some nerve pain.
  • Antidepressants may be given to manage depressive and suicidal thoughts.
  • Melatonin may be given to alleviate insomnia.

Detox Factors to Consider

The reason(s) why someone is taking benzodiazepines in the first place will have an effect on the detox process. For example, if the individual takes benzodiazepines to control seizures, as the benzodiazepine doses are reduced, another anti-seizure drug may be started. If the individual takes benzodiazepines for the control of panic disorder or anxiety, other anti-anxiety medications may begin during the detox to prevent anxiety or panic attacks.

Each detox experience is unique. An individual’s detox experience will depend on the level of dependency, the drug(s) abused, the method(s) of abuse, the dosage, and how long the drug(s) were abused. 

Where Can You Find Help With Benzodiazepines?

If you or a loved one is experiencing benzodiazepine dependence or addiction, recovery at a credentialed detox or treatment center can be the first step in sobriety. Look for a center with an experienced clinical staff that provides multiple treatment modalities, so they can incorporate the best methods in an individualized treatment plan for you or your loved one. 

People struggling with benzodiazepine abuse may also have other mental health issues, like an anxiety disorder or clinical depression. Co-existing disorders, such as a substance abuse disorder (SUD) and a mental health condition, is called a dual diagnosis. All conditions need treatment at the same time during rehab for successful recovery. If you or a loved one is struggling with a mental health condition and an SUD, look for a dual diagnosis rehab facility that can treat the benzodiazepine addiction and any psychiatric issues at the same time. 

Long-lasting recovery is possible when you make the changes needed to improve your mental, physical and emotional health and wellness through addiction treatment.

Resources

  1. https://www.drugabuse.gov/drugs-abuse/opioids/benzodiazepines-opioids
  2. https://livertox.nih.gov/BenzodiazepineDrugs.htm
  3. https://www.mdpi.com/2226-4787/6/2/43
  4. https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates
  5. http://stoa.usp.br/vahs/files/-1/16170/A+Historical+Dictionary+of+Psychiatry+-+Shorter+%5B2005%5D.pdf
  6. https://www.drugabuse.gov/publications/research-reports/misuse-prescription-drugs/what-scope-prescription-drug-misuse
  7. https://www.ncbi.nlm.nih.gov/pubmed/12891648